Hormone secreted by the left ventricle when the heart muscle is overstretched (from excess volume coming into the heart)

BNP (brain natriuretic peptide)

Stimulus for BNP to be produced

Excess volume/pressure coming into the heart

BNP level in a normal heart function

<100

BNP level indicative of mild heart failure

100-199

BNP level indicative of moderate heart failure

200-400

BNP level indicative of moderate to severe heart failure

>400

Amino Acid that your body uses to make protein and to build and maintain tissue

Homocysteine

If homocysteine levels are too high, what happens?

Encourages clot formation and causes the lining of the vessels to be thicker (inflammation occurs and damages to the inside lining of the artery occur). Therefore, elevated homocysteine levels contribute to strokes and heart problems

Normal Homocysteine Levels

4.6-11.2

Diagnostic Studies done for Cardiovascular disorders:

Chest Xray

Echocardiogram

-transthoracic

-transesophageal

Electrocardiogram (EKG/ECG)

Exercise Stress Testing

Myocardial Perfusion Imaging

Angiography (cardiac cath)

CT (computed tomography/ CAT scan)

Electrophysiology Study (EPS)

Venous Doppler Study & Duplex Scan

Purpose of Chest X-Ray

Helps determine the cause for symptoms that the patient is presenting.

It will tell if there is excess fluid (indicative of HF), size of the heart, etc. Bright spots that show up are calcium

Chest X-ray is a painless procedure that takes 15 min and evaluates the symptoms of:

Shortness of breath

Persistent cough

Chest pain

What is a major concern/question to ask if a patient is to undergo a chest x-ray?

PREGNANT?????

What is your role as a nurse during a Portable AP view Chest X-Ray on your patient?

Help pt. sit forward

Cover the cold, hard plate that is placed behind patient

Elevate the HOB

Ask patient to take a deep breath and hold (lowers the diaphragm and expands the lungs to get a better picture)

Dipyridamole (Persantine) - side effects last about 15-30 minutes (any type of Zanthene can counteract side effects (like caffeine)

Dobutamine - used mainly with stress echo

(used for pulmonary diseases: COPD/Asthma because it doesn't cause bronchoconstriction)

When administering Adenosine or Dipyridmole hold _______

caffeine for at least 24 hours before test;

medications that decrease HR

(ex: ccb, beta blockers)

Formula for Cardiac Output

CO = HR x SV

Abnormal Defects in Myocardial Perfusion Imaging:

Fixed - indicates infarc....dead and can't be revived

Reversible - indicates a difference between resting point and stress pictures (an angiogram/cardiac cath needs to be done to further diagnose problem)

Radioisotopes injected into IV for Myocardial Perfusion Imaging:

Thalium

Typical Standing orders of Stress Test:

Consent

NPO

No caffeine for 24 hours

Patent IV

Hold Meds that slow HR:

Beta Blockers

(Metoprolol, Carvedilol)

Digoxin

Calcium Channel Blockers

(diltiazem, Verapamil)

Procedure that requires an X-ray dye to be injected in a tube to take pictures of the heart. Large vascular access sheaths are placed in the groin or arm. Contrast dye is injected to detect impaired flow of blood to the coronary arteries

Angiography (cardiac cath)

Interventions for cardiac cath patient:

Check to see if pt has allergies to shellfish, iodine or other xray dyes!

Pressure is held for about 20-30 minutes after procedure - this allows for clot to form (hemostasis)...sometimes closure devices are utilized as the sheath is pulled out to obtain hemostasis fast

Most common site for the insertion of tube during cardiac cath

Femoral Artery - 1st choice

Brachial Artery - 2nd choice

Cardiac Cath usually lasts for about ____

1 hour

Typical Standing Orders for Cardiac Cath (Angiogram)

Consent!

NPO after midnight

IV access

Shave/prep right/left groin (with clippers!)

Hold Anticoagulants

- heparin (must be stopped the day of procedure)

- coumadin (must be stopped 4-5 days in advance)

- lovenox (12 hours before

procedure)

Check Allergy (iodine, shellfish, contrast dye)

(if allergic, give benadryl PO and solucortef)

Hold basal insulin and oral hypoglycemic agents (monitor blood sugar frequently though because they are NPO and you don't want them hypoglycemic)

*Some of the lipid is deposited on the arterial wall, forming fatty streaks.

*Activated macrophages also release biochemical substances that can further damage the endothelium by contributing to the oxidation of low-density lipoprotein (LDL). The oxidized LDL is toxic to the endothelial cells and fuels progression of the atherosclerotic process

*Following the transport of lipid into the arterial wall, smooth muscle cells proliferate and form a fibrous cap over a core filled with lipid and inflammatory infiltrate. These deposits, calledatheromas, or plaques, protrude into the lumen of the vessel, narrowing it and obstructing blood flow

*Plaque may be stable or unstable, depending on the degree of inflammation and thickness of the fibrous cap. If the fibrous cap over the plaque is thick and the lipid pool remains relatively stable, it can resist the stress of blood flow and vessel movement. If the cap is thin and inflammation is ongoing, the lesion becomes what is called vulnerable plaque. At this point, the lipid core may grow, causing the fibrous plaque to rupture.

*A ruptured plaque attracts platelets and causes thrombus formation.

*A thrombus may then obstruct blood flow, leading to acute coronary syndrome (ACS), which may result in an acute myocardial infarction (MI). When an MI occurs, a portion of the heart muscle no longer receives blood flow and becomes necrotic.The anatomic structure of the coronary arteries makes them particularly susceptible to the mechanisms of atherosclerosis.

*Atherosclerotic lesions most often form where the vessels branch, suggesting a hemodynamic component that favors their formation

*Although heart disease is most often caused by atherosclerosis of the coronary arteries, other phenomena may also decrease blood flow to the heart. Examples include vasospasm (sudden constriction or narrowing) of a coronary artery and profound hypotension.

Clinical Manifestations of CAD (coronary artery disease)

Angina Pectoris...caused by myocardial ischema and usually atherosclerosis

Sudden Cardiac Death (may be first indication of coronary atherosclerosis)

Risk Factors that increase the probability of a person developing heart disease (CAD):

Nonmodifiable Risk Factors

Family history of CAD (first-degree relative with cardiovascular disease at 55years of age or younger for menand at 65 years of age or younger for women), Increasing age (more than 45 years for men; more than 55 years for women), Gender (men develop CAD at an earlier age than women), Race (higher incidence of heart disease in African Americans than in Caucasians)